When I was a teenager I served on a committee at my church. After a long and painful meeting another member told me: “When all is said and done, a great deal more is said than done.” I still laugh when I think of it

I’ve written several posts on the Republican promise to “repeal and replace” the Affordable Care Act. Perhaps it’s time to take a step back and look at how we got here.

From the 2nd half of the 20th Century different Presidential administrations have sought to make health care available to everyone. As far back as 1945 we’ve been hearing about this. In November of 1945, Democratic President Harry Truman (seven months into his first term) said this: “The health of American children, like their education, should be recognized as a definite public responsibility.”

Alas, he was not able to make this happen. But 20 years later Democratic President Lyndon Johnson signed into law Medicare (health care for those 65 and older) and Medicaid (health care for the poor).

It’s worth noting that the Republican Party fought hard against all three. You can read an excellent article here.

From his first days in office in 2009 President Obama pledged to provide health care to those who had previously been left out because they had pre-existing conditions, or worked for employers who didn’t offer health insurance, or couldn’t work. You can find an excellent timeline here. It wasn’t easy, but he signed the ACA bill on March 23, 2010.

When Social Security, Medicare, and Medicaid became the law of the land the Republicans soon learned that these programs were both popular and permanent. Both parties then learned to cooperate and make regular updates that benefited the American people.

Not so with the ACA. Republicans who wanted nothing other than President Obama’s defeat latched onto this as a path to destroy his Presidency. You can read about it here. Simply put, while they failed in the courts, they found moderate success in frightening insurance companies away from entering markets in states that declined the Medicaid expansion (and threw overboard their poorest citizens in favor of settling political scores).

Meanwhile they’ve spent the last seven years promising to replace the ACA with something “better and cheaper.” Five days before his inauguration President Trump promised insurance for everybody. But if we’ve learned anything from the last six months, we’ve learned that while the Republicans pledged to replace the ACA they’ve spent not one minute figuring out how to do it. No plan, no framework, no work at all.

In fairness they’ve enjoyed the luxury of making promises they never expected to have to keep. That all changed in November.

So here’s the problem: these Republicans now have to choose between a moral compass and their job security. I don’t envy them because it’s not a fair fight. They continue to claim that they serve their constituents but the latest national poll shows that most Americans support the ACA and only 12% of counties who voted for President Trump support the ACA’s replacement. This morning we learned that a group called the Senate Conservatives Fund are already targeting Republican Senators who didn’t support the latest Senate bill to replace the ACA.

In my last few posts I’ve talked about the Senate Healthcare Bill, also known as the Better Care Reconciliation Act of 2017. My last post centered on its effect on Medicaid.

Today I wish to focus on another aspect: the Affordable Care Act (Obamacare) listed 10 things that all health insurance were required to provide:

Ambulatory patient services. [outpatient care]
Emergency services.
Hospitalization. [inpatient care]
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment.
Prescription drugs.
Rehabilitative and habilitative services and devices.
Laboratory services
Preventive and wellness services and chronic disease management;
Pediatric services, including oral and vision care.

These were chosen because several of them are exactly the benefits that are denied when times get tough. You can find an excellent article from National Public Radio that compares Obamacare, the House bill, and the Senate bill.

For the purposes of this post I’m going to drill down on just one: mental health and substance use disorder services, including behavioral health treatment. With Obamacare your health insurance required them to pay for mental health services, but both the House and Senate bills allow states to apply for waivers that would not require them to pay for this.

We’ve been hearing more and more about this, but opioid addiction has skyrocketed in the last few years. In fact, in March Mr. Trump appointed former New Jersey Governor Chris Christie to lead a new commission to battle opiod abuse.

Thing is, many addicts who seek treatment are able to pay for it through Medicaid. The percentage varies from from state to state. States that are hardest hit by addiction rely heavily on Medicaid to pay for this treatment. In Ohio it’s 49%, West Virginia it’s 45%, Kentucky it’s 44%.

The GOP plan will decimate Medicaid and make it harder for those who seek sobriety. We’ve been reading in the last few days that the Senate is looking at adding $45 billion for drug treatment but this isn’t nearly enough.

I’ll be writing more about how we all benefit from Medicaid, but healing addiction helps everyone.

In my last post I spoke about the Senate health care bill and how they needed to find a way to compel insurance companies to cover people with pre-existing conditions while eliminating the individual mandate to purchase health insurance. This should come as no surprise, but they found their target: Medicaid.

But first, a little background. Life expectancy (ie, the average age when you can expect to die) shot up in the 20th century. In 1900 it was 47 years. But 100 years later that number increased by 60% to 75 years. By the 1950s and 1960s it became clear that people were living longer after they retired from work, and often lost health insurance. On July 30, 1965 President Lyndon B. Johnson signed legislation that led to the creation of Medicare.

In addition to the elderly, we found that millions of poorer Americans were locked out of even basic healthcare. The same bill that brought us Medicare also brought us Medicaid.

By 2011 CNS News estimated that over 108,000,000 Americans accessed health care from one or both of these programs. On May 21, 2015 Donald Trump promised not to cut Social Security, Medicare, or Medicaid.

Simply put, President Trump’s promise to sign whatever version of the American Health Care Act (AHCA) breaks his previous promise. The House version (HR1628) would, in the next 10 years, cut Medicaid by $880,000,000 and throw 14,000,000 Americans overboard.

We’re still waiting on the numbers on the Senate bill (the Congressional Budget Office should have the numbers early next week), but early analysis shows these numbers won’t be any better.

So why should we care about Medicaid? Fair enough. There are those who honestly believe that poverty is a self inflicted wound and that by providing anything we are encouraging laziness.

But many Americans depend on Medicaid on either end of life. According to their own web page, Medicaid provides health insurance to 35,000,000 children and 35,000,000 elderly.

As a nation we’re much better off providing health care to children. Not treating children for an earache with antibiotics places the child at risk for meningitis or hearing loss. Not vaccinating children places them at risk for a host of dangerous and preventable diseases. Healthy children become healthy adults. They grow up, get jobs, and create wealth that provides for all of us.

On the other hand, there is little downside to ignoring the elderly (except that they vote in high numbers). Nobody wants to spend the last years of his life in a nursing home, but 60% of nursing home residents rely on Medicaid for their care.

In other words, funding Medicaid does two things: it makes our children less dependent on needing further treatment and it insures our elderly poor aren’t found days after their death or don’t die on park benches.

Then again, believe President Trump’s promises at your own risk.

When I began the Trump Chronicles last November I hoped to chronicle his Presidency. Frankly there’s so much drama it’s hard to keep up. I never thought I’d be able to keep up with the President’s tweets for two reasons: I don’t have a twitter account, and unlike the President I have a full time job.

But I was driving home from work this afternoon listening to the news and knew I needed to blog on the state of legislation on health care. Since its inception in 2010 the Republican Party has made repeal of the Affordable Care Act a priority. At every opportunity they’ve attempted to sabotage it. Despite their best efforts, the ACA continues to enjoy popularity.

And despite the will of the American people, the GOP continue to insist on a mandate to repeal and replace.

In May the House of Representatives passed HR 1628 and frankly we found much of it horrifying. Even the President called it mean and suggested the final plan as generous, kind, with heart.

Previous to the Affordable Care Act, insurance companies could pick and choose who they cover. They could deny coverage for someone with a pre-existing condition. And to be fair, that makes sense. If you’re an insurance company you don’t want someone to live without health coverage in their young and healthy years, only to demand coverage after being diagnosed with cancer, diabetes, or dementia. But it also meant that if you had something as simple as sleep apnea, and could not get insurance from your employer, you were out of luck.

The Affordable Care Act recognized this and mandated coverage even if you’re young and healthy. It’s much the same as requiring you to have car insurance even if you’re a safe driver. But this health care mandate led to some of the largest whining among conservatives. Under the banner of “no one can tell me what to do with my money,” they screeched that this diminished the freedom of those who were willing to take their chances. But when Massachusetts Governor Mitt Romney authored a health plan with an individual mandate in 2006, he characterized it as a personal responsibility. He went on to say that it was “immoral” for those who can afford health insurance not to buy it.

And yet the GOP demanded the removal of the individual mandate which left them with a problem: how will they pay for this? Well, they went back to their playbook to reward the wealthy and punish the poor. More later.

History buffs like me perked up last week when former FBI director James Comey dropped a reference to British King Henry II (1133-1189) and Archbishop of Canterbury Thomas Becket (1118-1170).

Maine Senator Angus King asked Mr. Comey this question: “You said [Trump] said, ‘I hope you will hold back on [the investigation] of this.’ But when a president of the United States in the Oval Office says something like ‘I hope’ or ‘I suggest’ or ‘would you,’ do you take that as a directive?” Mr. Comey responded: “Yes. Yes, it rings in my ear as kind of, ‘Will no one rid me of this meddlesome priest?’” Senator King answered: “I was just going to quote that in 1170 [of] Dec. 29 Henry II said, ‘Who will rid me of this meddlesome priest?’ And then the next day he was killed. Thomas A Becket. That’s exactly the same situation. We’re thinking along the same lines.”

And so a little background: Henry II was the King of England from 1154 until his death. Thomas Becket was his best friend, and chancellor (being appointed in 1155). In 1162 Becket was named Archbishop of Canterbury (while it was still a Catholic office). Henry assumed his best friend would chose loyalty to him over loyalty to Pope Alexander III.

He was wrong. Becket disagreed with Henry on several occasions which caused great anger in the king. In 1170 Henry famously cried: “Will no one rid me of this troublesome priest?” Four of those present interpreted this as a directive to kill Becket. On December 29, 1170 they killed Becket.

Mr. Comey no doubt used this image to interpret his conversation with President Trump on February 14th. By all accounts Mr. Trump asked Attorney General Jeff Sessions and aide Jared Kushner to leave the room, and then said this to Mr. Comey: “I hope you can see your way clear to letting this go, to letting Flynn go. He is a good guy. I hope you can let this go.”

Mr. Comey did not see this as “I hope” but instead as “You will.” The fact that Mr. Comey was later fired makes his case stronger. He felt he was being ordered to stop the investigation in the same way that King Henry’s knights believed they were acting on orders from their king.

As a footnote, Mr. Trump’s son appeared on Fox News and said this: “When he tells you to do something, guess what? There’s no ambiguity in it, there’s no, ‘Hey, I’m hoping.'” (You can read the article in the Washington Post).

I doubt Mr. Comey will become a saint as St. Thomas Becket did, but I loved his reference.

I’m finding it increasingly difficult to hold down a full time job and keep up with the damage caused by President Trump. Last month I wrote about his firing of FBI director James Comey. I had hopes of writing followups but just couldn’t get to it.

Last week I read, along with the rest of us, that President Trump has decided to withdraw from the Paris Climate Agreement. I’ve been writing this blog post in my head ever since, and I’m determined to post it regardless of the fact that President Trump has continued to create chaos and pain following the recent terrorist attacks in Manchester and London.

Perhaps when I retire I can do this full time, but for now I can’t keep up. Nevertheless I think an article on the Paris Accord still needs to be written.

For the last several decades most of us have recognized that our ongoing burning of fossil fuels harms our planet. We burn coal, natural gas, and oil to create heat. We use that heat to warm our homes and power our transportation. And to be fair, in the last 200 years these fossil fuels have allowed us to take for granted our ability to be warm (or cool, given air conditioning) and travel anywhere on our planet within a few hours.

But in the middle of the 20th Century some scientists began to notice that burning fossil fuels emitted the gas carbon dioxide, or CO2. CO2 is a greenhouse gas which means it “traps” heat that comes to us from the sun. A greenhouse gas allows heat into the atmosphere but prevents it from leaving. Greenhouses are used by botanists who want to grow plants and flowers in cold climates.

But when understood globally, greenhouse gases trap heat in a way that raises the temperature of the entire planet. We’re already seeing record warming of the Artic region that is melting polar ice and we face the reality that this will raise global sea level and flood low lying landmasses. Because climate change is a global reality it needs a global solution.

Last year countries from all over the world gathered and agreed on the Paris Accord. Simply put it meant that all countries would work to limit greenhouse gases.

Since World War II the United States has been called the Leader of the Free World. No longer.

President Trump attempts to play this as a bad deal for the United States. It isn’t. The only thing his move will do is remove us from a seat at the table and marginalize us.

Climate change is real and it’s not too late to for us to turn away from fossil fuels and toward renewable energy. But President Trump and others who deny clear science do not protect jobs. They just look like idiots. More later.

Today marks a week since the firing of FBI director James Comey. It’s been quite a week and it’s hard to imagine a week that’s shown better how President Trump can create chaos.

My best example comes from the series of explanations President Trump gave for the firing:

1. It wasn’t my idea. In the letter Mr. Trump sent to Mr. Comey, he claimed he was simply responding to the recommendation of Attorney General Jeff Sessions and Deputy Attorney General Rob Rosenstein. This didn’t last long as Mr. Rosenstein threatened to resign unless the White House admitted that he wrote his memo at the direction of the President (he has since denied this).
2. It was because of his treatment of Hillary Clinton during the Presidential campaign. This didn’t last long as there was tape of Mr. Trump praising Mr. Comey last October 31st. Last Thursday Mr. Trump sat down with NBC News anchor Lester Holt and said this (I did some editing for clarity the previous link takes you to the interview):
   

   Mr. Trump: [Rob Rosenstein] made a recommendation. He’s highly respected. Very good guy, very smart guy. And the Democrats like him. The Republicans like him. He had made a recommendation. But regardless of recommendation, I was going to fire Comey knowing there was no good time to do it. And in fact, when I decided to just do it, I said to myself — I said, you know, this Russia thing with Trump and Russia is a made-up story. It’s an excuse by the Democrats for having lost an election that they should’ve won.

   In other words he didn’t act on Mr. Robenstein’s recommendation because he had already decided to fire Mr. Comey (and fired him for a different reason).

3. Mr. Comey led the FBI poorly. In the same interview with Mr. Holt, Mr Trump said this:
   

   “Look, he’s a showboat. He’s a grandstander. The FBI has been in turmoil. You know that, I know that, everybody knows that. You take a look at the FBI a year ago, it was in virtual turmoil — less than a year ago. It hasn’t recovered from that.” It’s worth noting that the FBI’s interim director, Andrew McCabe said this: “I can tell you that I hold Director Comey in the absolute highest regard. I have the highest respect for his considerable abilities and his integrity and it has been the greatest privilege and honor in my professional life to work with him. I can tell you also that Director Comey enjoyed broad support within the FBI and still does until this day. We are a large organization, we are 36,500 people across this country, across this globe. We have a diversity of opinions about many things, but I can confidently tell you that the majority — the vast majority of FBI employees enjoyed a deep and positive connection to Director Comey.

It’s been my experience that when someone gives me several reasons for an action or decision, it’s usually because he doesn’t want me to know the real reason. Today we learned that in February Mr. Trump asked Mr. Comey to end the Russia probe. It’s not a stretch to think that Mr. Trump fired Mr. Comey out of disloyalty. Mr. Comey chose serve his country over his boss. If this is true, bravo Mr. Comey.